EMPIRICAL STUDIES
12793
The effect of education and telephone follow-up intervention
based on the Roy Adaptation Model after myocardial
infarction: randomised controlled trial
Selma Turan Kavradim PhD, RN (Assistant Professor)
Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
Scand J Caring Sci; 2019
The effect of education and telephone follow-up
intervention based on the Roy Adaptation Model
after myocardial infarction: randomised controlled
trial
Background: Patients’ lifestyle changes after myocardial
infarction reduce the risk of infarction. Nursing interven-
tions are important for the initiation and maintenance of
lifestyle adaptation.
Aim: The aim of this study was to evaluate the effect of
education and telephone follow-up intervention based on
the Roy Adaptation Model for improving myocardial
infarction patients’ self-efficacy, quality of life and life-
style adaptation.
Method: In this parallel, randomised controlled trial,
patients were randomly allocated to a control group or
an intervention group (n = 33/group). The control group
received routine care, while the intervention group
received routine care plus a telephone follow-up inter-
vention, which consisted of a predischarge education pro-
gramme and three telephone follow-up sessions. Data
were collected before discharge, in the 12th week after
discharge between April 2016 and August 2017. All
Introduction
According to the European Society of Cardiology Guide-
line (2018), cardiovascular disease is the leading cause of
deaths; it was responsible for 17.5 million deaths with
46% of these deaths, an estimated 7.4 million, due to
ischaemic heart disease (1). Myocardial infarction (MI)
has an important place in ischaemic heart diseases. It
Correspondence to:
Selma Turan Kavradim, Department of Internal Medicine Nursing,
Faculty of Nursing, Akdeniz University, Antalya, Turkey
E-mail: selmaturan@akdeniz.edu.tr
Name of trial registry of Clinical Trials: The Effect of Education and
Telephone Follow-up Intervention Based on the Roy Adaptation
Model, Identifier: NCT03771937
© 2019 Nordic College of Caring Science
doi: 10.1111/scs.
and €
Zeynep Canli Ozer PhD, RN (Professor)
outcomes were assessed at baseline and at 12 weeks, and
included quality of life, coping adaptation process, self-ef-
ficacy and lifestyle changes. The CONSORT checklist was
used in the study.
Results: In the 12th week after discharge, patients in the
intervention group had significant improvements in self-
efficacy, quality of life and coping adaptation process
compared with the control group. The intervention group
also had more adaptation lifestyle changes concerning
patients nutrition and physical activity in the 12-week
follow-up.
Conclusion: This study demonstrated that education and
telephone follow-up intervention based on Roy Adap-
tation Model was had positive and significant results
after 12 weeks compared with usual care. The findings
of this study are important for supporting nursing
practice and health professionals who care for individ-
uals with myocardial infarction to develop nursing
care.
Keywords: lifestyle change, myocardial infarction, nurs-
ing, telephone follow-up, Roy Adaptation Model, self-
efficacy.
Submitted 28 May 2019, Accepted 17 October 2019
commonly appears during productive age, together with
acute postrhythm problems, heart failure, angina and
recurrence of MI (2,3). The social, psychological and
physical problems that occur after MI affect the quality of
life and self-efficacy (4) and make it difficult to adapt to
lifestyle change (3,5).
Lifestyle interventions for secondary prevention are
strongly emphasised by the guidelines of the European
Society of Cardiology and the American Heart Associa-
tion (1,6). Key lifestyle interventions include cessation of
smoking, diet advice, weight control and encouraging
physical activity (1). During the hospitalisation after MI,
the time for implementing secondary prevention is lim-
ited and nursing interventions are important for the initi-
ation and maintenance of lifestyle interventions (1,7).
Studies show that patients’ lifestyle changes after MI
1
2 €
S. Turan Kavradim, Z. Canli Ozer
reduce the risk of infarction (1,6), but patients have diffi-
culty in making the changes. Because lifelong habits are
not easily changed, these changes take a long time (1,7).
Many techniques are used to improve adaptation to
lifestyle changes, such as home visits, telephone follow-
ups, self-management enhancement, patient education
and counselling (8,9). Among these interventions, it has
been stated that education is an effective method for risk
factor control and adherence to lifestyle change in that it
increases awareness and responsibility and also that fol-
low-up of these changes is important (1). Telephone fol-
low-up is an effective method of increasing quality of life
and self-efficacy, reducing stress and avoiding recurrent
hospitalisations (7,10,11). Recent meta-analyses of RCTs
have reported that telephone follow-up interventions are
associated with improvements in adaptation and lifestyle
changes (12–14). To reduce the rate of repeated cardio-
vascular events and improve adaptation, single methods
are commonly used in the literature, but it is thought
that the use of theoretical intervention applications in
combination with other methods based on evidence to
improve adaptation may be more effective. It is known
that the theory-based interventions contribute to an
increase in the effectiveness of nursing interventions
(15,16). Although some studies have been found in the
literature on improving quality of life, self-efficacy and
adaptation for patients with MI (7,10,11), no studies
have been reported on the education and telephone fol-
low-up intervention of patients with MI based on Roy
Adaptation Model (RAM).
RAM is an adaptation theory and interaction model,
which focuses on interaction between humans and the
environment as the basis of a conceptual model of nurs-
ing. It was developed in the 1960s by Sister Callista Roy
(16,17). The model is the most widely used and is being
continuously tested and developed in the field of nursing
research, practice and education (17). Physiological pro-
cesses (regulator subsystem) and cognitive and emotional
processes (cognator subsystem) holistically interact to
maintain personal integrity and foster adaptation and
personal growth. Because the regulator and cognator
subsystems are internal processes and cannot be directly
observed, these subsystems have been defined as adap-
tive modes (physiological mode, self-concept mode, role
function mode and interdependence mode) (16,18).
According to the model, the main concept of which is
adaptation, the purpose of nursing is to create effective
adaptive behaviours in these adaptive modes by using
the regulator subsystem and cognator subsystem of indi-
viduals against stimuli (focal, contextual and residual)
and to take the individual to an excellent level of adapta-
tion (16,18). The reason for preferring the RAM in this
study is its potential to be continuously used, tested and
improved in different patient groups. It strengthens adap-
tation by affecting the areas of physiology, self-concept,
role function and interdependence of individuals with
MI. According to the RAM, ‘person’ is the individual
who has undergone MI; ‘environment’ according to Roy
is the environment of the individual who has undergone
MI and consists of focus stimuli, affecting stimuli and
potential stimuli. ‘Health’ is the passing of the person
who has undergone MI from a state of unbalance to a
state of balance. ‘Nurse’ is the person who supports the
patient in the four adaptive fields by means of the nurs-
ing care given, who evaluates factors affecting behaviours
and adaptation skills, and who contributes to the health
and quality of life of the patient by increasing environ-
mental interaction. After MI, patients can show negative
coping behaviours such as denial of the disease and emo-
tional exhaustion, feelings of shame and guilt, insecurity,
and depressive and disease-centred behaviours (19). An
increase in adaptation enables patients to return to an
active life after MI, to pursue their lives in a healthy way
and to continue life under the best physical, mental and
social conditions (9,20).
Aims
The specific aim of this study was to evaluate the effect
of education and telephone follow-up intervention based
on RAM for improving MI patients’ self-efficacy, quality
of life and lifestyle adaptation. We hypothesised that edu-
cation and telephone follow-up intervention based on
RAM would (a) increase quality of life, (b) improve the
coping and adaptation process, (c) increase self-efficacy
and (d) enhance adaptation to lifestyle changes.
Methods
Study design
This study had a prospective, parallel, RCT research
design. Patients were randomly allocated who were
being treated for myocardial infarction in the hospital
and who met the inclusion criteria of the control group
or the intervention group. This study is based on rec-
ommendations from CONSORT Statement (See
Appendix S1) (21).
Participants and setting
This study was conducted at the Clinic and Polyclinic of
the Department of Cardiology of University Hospital in
Antalya, Turkey, between April 2016 and August 2017.
Inclusion criteria of the study were as follows: (a) partici-
pants were adults aged ≥ 30 years and had been admitted
to the hospital with a diagnosis of MI (which must be
supported by ECG and an increase in biomarkers), (b)
were clinically stable, (c) willing to participate, (d) able
to understand and write Turkish, (e) able to receive
© 2019 Nordic College of Caring Science

telephone calls or fill in questionnaires, and (f) able to
come to the hospital for checkups. Patients were
excluded from the study if according to medical file
records they had chronic renal failure, cancer, heart fail-
ure, and severe aortic stenosis, if they were planned for
surgical treatment or had chronic cognitive and psychi-
atric disease, if they had problems with hearing and
speaking on the phone, or if they had mobility
restriction.
Randomisation
The simple randomisation method was chosen as the
randomisation method to provide an equal number of
samples in the intervention and control group. During
the study period, patients were recruited from the cardi-
ology clinic according to the inclusion criteria and ran-
domly assigned to either the intervention group
(n = 33) or the control group (n = 33) before pretest
data were collected. In order to randomise patients
according to the date of admission to the hospital, the
next envelope of those that had been prepared was
opened, and this determined whether the patient was
assigned to the intervention or the control group. Once
group allocation was decided, each subject was informed
in writing what his or her participation in the study
involved. The allocation was kept in sequentially num-
bered opaque envelopes by researcher. Single blinding
was provided that included inclusion criteria and agree-
ment to participate in the study. Patients did not know
whether they were included in the intervention group
or the control group. The patients were told that this
was a study with two parallel monitored groups. How-
ever, they were not told about the interventions applied
to the other group.
Data collection
The aims of the study and the research process were
explained to the patients who were being treated and fol-
lowed up at the cardiology clinic because of MI, who had
had an acute period of illness and who fitted the inclu-
sion criteria, after which their informed voluntary con-
sent was obtained with an Approval Form prepared in
line with the Helsinki Declaration. Collection of research
data was performed by the researcher by face-to-face
interview. Baseline data on quality of life, self-efficacy
and the coping adaptation process and adaptation to life-
style changes were collected at the hospital after ran-
domisation. Baseline data of the study were collected by
providing a quiet environment in the patient’s room in
the cardiology clinic between 9.00 and 12.00 hours, out-
side visiting time. Demographic and clinical data were
collected by self-report and from medical records during
hospital stays. The data collection period lasted
© 2019 Nordic College of Caring Science
Education and telephone follow-up intervention 3
approximately 30 minutes for each participant. After this,
patients in the intervention groups were given education
by the researcher, with the help of an education booklet.
After the patients in the intervention group were dis-
charged from hospital, they were followed up and given
counselling by telephone by the same researcher. Post-
test data were collected by the researcher in the 12th
week after discharge when the patients arrived at the
polyclinic for checkup.
Preliminary application
To examine the feasibility of the research and the inter-
vention, research processes were applied as preliminary
applications to three patients with MI and patients inter-
viewed were not included in the study sample. Following
the preliminary application, a number of changes were
made to the study. Two sessions were originally planned,
but because patients were discharged from hospital in a
short time, this was reduced to one.
The intervention
The intervention group received face-to-face education
with an education booklet during the hospital, and after
discharge, three structured telephone call follow-up
interventions were conducted.
The education booklet was prepared by the researcher
according to the needs of the patients to know their risk
factors, to help the patients to establish an attitudinal
and knowledge foundation and adapt to the postdisease
lifestyle changes of patients with MI, based on evidence-
based treatment guidelines and RAM (1,6,18,22). In
accordance with the Discern Guide (23), ten expert opin-
ions were obtained. In addition, the booklet and the edu-
cation plan were translated into English and sent to
Sister Callista Roy via e-mail. We received positive feed-
back from Roy regarding the suitability of the booklet,
the CTE diagram and the education plan. The education
booklet had 33 pages and covered a range of topics
including cardiovascular risk factors, lifestyle change and
psychosocial support, the use of drugs, healthy nutrition,
active life and exercise, sexual life, smoking and alcohol
use, emotions and coping, and tests used in cardiology.
This education booklet was supported by visuals and
tables.
Education with the booklet. Education was delivered by
the research assistant, who had previous experience and
training in cardiology nursing and interviewing. Each
education session was conducted for 30-45 minutes and
in line with the goals set out in the education plan. Dur-
ing the education session, patient participation and ques-
tioning was encouraged and supported. In order to make
it easy to remember important points, marking was done
4 €
S. Turan Kavradim, Z. Canli Ozer

with the patient in the booklet, and the booklet was pain which did not respond to nitroglycerin, palpitations,
given to the patients to recall and read again. severe breathlessness, symptomatic hypotension, uncon-
sciousness or syncope, and they were directed to the
Telephone follow-up. Three structured phone calls were polyclinic if they had side effects of medicines.
conducted in the first, third and eighth weeks following The process of using a conceptual model to guide
discharge from the hospital and each call was limited to research requires the construction of a conceptual–theo-
15—20 minutes. During these phone calls, the researcher retical–empirical (CTE) structure and communication of
engaged the patient in sharing potential barriers to that structure in a diagram and a narrative (15). The CTE
adherence or other factors that might contribute to poor structure for this study is given in Fig. 1. This CTE struc-
disease control, discussed the patient’s readiness to mod- ture provided a systematic framework to guide the evalu-
ify behaviours and worked with the patient to agree on a ation of patient data through a holistic approach,
shared plan of strategies to improve adherence and dis- planning and analysis of applications.
ease control. For telephone calls, a form was prepared
including telephone follow-up and interview steps by the Control group. All patients in the control group received
researcher. The form consisted of appropriate lifestyle usual care. Usual nursing care at the hospital consisted of
measures and adaptation to follow, and covered patient giving drug prescriptions, giving diet recommendations to
assessment, identification of problems, experience of patients with a high cholesterol level and giving the
physical and emotional problems, adherence the lifestyle times to come for checkup at the time of discharge. Ethi-
change and reminders on issues patients deemed neces- cally, the patients in the control group were trained by
sary, health checks, identification of common goals, and the researcher with the education booklet when they
encouragement and enhancement of self-efficacy, finish- completed the study.
ing and planning. Individually tailored telephone consul-
tation was also conducted by the researcher. In the
Outcome measures
telephone calls, the researcher was available and coun-
selling was provided to patients any time it was needed. The primary outcomes were patients’quality of life, cop-
Counselling was conducted under a protocol. In this pro- ing adaptation process and self-efficacy from baseline (in
tocol, patients were directed to the emergency clinic if hospital) to 12 week after randomisation. The secondary
they had chest pain that lasted more than 15 minutes, a outcomes were the change from baseline to 12 week
pain which spread to the neck, lower jaw or left arm, a after randomisation of fasting triglyceride, high-density

Conceptual Stumuli
Subsystems
Biyo-Psycho-Social response
modes
Focal Contextual Residual
Regulator Cognator
Self-concept Inter-
Myocardial Age, gender, genetics, Beliefs about the Physiological Role-function dependence
infarction education level, disease, cope with Neural, Perceptual,
knowledge about the the unknown factor chemicals, informational, learning,
disease and treatment, that will affect endocrine decision making,
economic conditions emotional
Lifestyle (nutrition- Complications, Drugs Psychosocial Changing roles Social
exercise-stress, life activities changes and functions support
alcohol, smoking), (Diet, exercise, ...) needs
Coping mechanisms
obesity MIDAS
Physiological processes after disease
MIDAS CAPS CAPS MIDAS
Dealing with the problem after disease
Coping and Adaptation Process Scale Morisy Scale General Self- CAPS
Theory General Self-Efficacy Scale
CAPS
Efficacy Scale

Hospital
records

Data collection form based on RAM

Empirical
Self-efficiency Quality of life Adaptation level in health
behavior
Research design Intervention
Randomised Samples Nursing Care Based on RAM
MI patients Ineffective Responses Adaptive
Controlled Trial
responses
Education and telephone follow-up

Figure 1 Conceptual–theoretical–experimental structure to myocardial infarction

© 2019 Nordic College of Caring Science


lipoprotein cholesterol (HDL) and LDL, body mass index,
dietary behaviour, smoking behaviour and walking for
exercise.
All participants completed a Personal Information
Form which contained 50 items that included demo-
graphic and disease-related information and cardiac
physiological risk parameters. This form was created by
the researcher and was piloted by nursing professionals
(15–18). The self-efficacy levels of the patients were
measured by the General Self-Efficacy Scale (GSES). The
GSES contains 10 items, and each item score ranges
from 0 to 5 (24). Cronbach’s a of the GSES was 0.83.
The highest and lowest possible score is between 10 and
40. High score indicates that the individual perceives
high self-efficacy (25). To evaluate the coping and adap-
tation processes, the Coping and Adaptation (CAPS)
scale was used. The CAPS was developed by Callista Roy
(22). The Turkish validity and reliability study of the
scale was conducted by C ß atal and Dicle (2015) (26), and
the Cronbach alpha value was 0.82 for the total scale.
The highest and lowest possible score is between 47 and
188. Higher scores indicate better use of effective coping
methods (26).
To evaluate the quality of life after the disease, the
Myocardial Infarction Dimensional Assessment Scale
(MIDAS) was used. This was developed by Thompson
et al. in 2002. The Cronbach alpha values of the scale
were found in seven dimensions, and ranged from 0.74
to 0.95, showing it to be a useful and highly reliable tool
(27). The validity and reliability study of the scale was
made by Yilmaz et al. Cronbach alpha values ranged
from 0.79 to 0.90. The highest and lowest possible score
is between 0 and 100, with 0 indicating the best health
condition and 100 indicating the worst health condition
(28). Also, the Morisky Adherence Scale was used to
measure medication adherence. The scale was validated
by Morisky, Green and Levine in 1986. The Cronbach
alpha value was found to be 0.61 (29). The validity and
reliability study of the scale was conducted by Bahar
et al., and it was found to be a valid and reliable instru-
ment (30). Because of the participation in the research of
patients who did not have continuous medication, this
scale did not apply in baseline.
Data analysis
The sample size calculation was based on the conven-
tional method of power analysis by using a medium
effect size of 0.5, a power of 0.85 and a significance level
of 0.05. All statistical analyses were conducted with the
SAS 9.4 package. The test of conformity of the data used
primarily to normal distribution was performed with the
Shapiro–Wilk test. The results of the test indicated that
the data showed normal distribution, and parametric tests
were used. In two-way comparison between two-
© 2019 Nordic College of Caring Science
Education and telephone follow-up intervention 5
category variables, t-test was applied for independent
groups, and in order to find the differences between vari-
ables with three or more categories, ANOVA analysis was
applied. As a test of the time of two different measure-
ments obtained from the same individuals, the paired
sample t-test was used. Repeated measures variance anal-
ysis was used to examine whether there were differences
over time and between groups in mean scale scores, and
chi-square or the Fisher’s exact chi-square test was used
to see whether there was a difference in categoric vari-
ables between the experimental and control groups. In
the whole of the study, the significance level was taken
as 0.05.
Results
Characteristics of study participants
During the application phase of the study, 141
patients with a diagnosis of MI were evaluated, and
of these, 66 consented to participate in this study.
However, four patients were lost to follow-up: contact
was lost with two patients, and two patients did not
come for checkups in the hospital (Fig. 2). The demo-
graphic and clinical characteristics of the patients are
shown in Table 1. No differences among the control
and the intervention group were noted in terms of
according to sociodemographic characteristics. The
majority of participants were male (51/66, 82.26%)
with a mean age of 57.79 years (SD = 11.17), 53.23%
were not working, and 66.13% had a family history
of heart disease.
Quality of life, self-efficacy and coping and adaptation
In a comparison of quality of life data with MIDAS, phys-
ical activity (F = 2.86, p = 0.0049), insecurity (F = 2.73,
p = 0.0072), emotional reaction (F = 2.72, p = 0.0074)
and side effects (F = 3.50, p = 0.0006) revealed a signifi-
cant difference between the two groups from the baseline
to the 12th week (Fig. 3). However, other domains of
MIDAS no statistically significant differences were
observed (Table 2; Fig. 3). As shown in Table 2, there
were also significant improvements in self-efficacy (F=
4.22, p = 0.0001) in the intervention group. Addition-
ally, comparison of the coping and adaptation process
with CAPS between groups revealed a significant differ-
ence (F= 4.54, p = 0.0001) at 12 weeks (Fig. 3). There
were no statistical differences between the groups for
medication adherence. It was determined that 96.77% of
the intervention group and 93.55% of the control group
continued medication use. Also, both groups were found
to show high adherence to regular use of the medication
(83.87% in the intervention group and 77.42% in the
control group).
6 €
S. Turan Kavradim, Z. Canli Ozer
Figure 2 Flow diagram of the study
Changes in lifestyle habits between the two groups during the
12-week study period
There was a higher adherence level in the intervention
group than in the control group on active lifestyle and
physical activity (p < 0.001). Also, a meaningful difference
was found in dietary behaviour between the two study
groups, with better results among patients who received
intervention (p = 0.023). The intervention was not effec-
tive on smoking cessation (p = 0.608) or symptoms experi-
enced (p = 0.194) (Table 3). The effect of the intervention
on physical parameters, serum high-density lipoprotein
(p = 0.045) and waist circumference (p = 0.011) was
confirmed and there was a significant difference between
the groups. However, no significant differences were
observed in other outcomes (p> 0.05) (Table 4).
Discussion
This study reported conducting a holistic intervention
related clinically important topic and aimed at improving
self-efficacy, quality of life and coping adaptation process
to lifestyle changes post-MI. The innovative aspect of this
study was that a nursing model was integrated into edu-
cation and telephone follow-up intervention on adapta-
tion for MI patients. To our knowledge, this study is the
first RCT to evaluate the effectiveness of education and
telephone follow-up intervention based on the RAM for
improving MI patients’ self-efficacy, quality of life and
lifestyle adaptation. This study demonstrated that educa-
tion and telephone follow-up intervention based on the
RAM was effective and applicable to increasing self-effi-
cacy, the coping and adaptation process and quality of
life, and to potentially enhancing exercise and diet
adherence in MI patients.
Quality of life, self-efficacy and coping and adaptation process
In this study results show that there was an increase in
the quality of life during the follow-up in the interven-
tion group, but that the control group showed a decrease
in quality of life during the follow-up period (Fig. 3).
Among the reasons why the intervention was effective, it
is thought that the MIDAS quality of life scale is related
to four bio-psycho-social response modes. There are simi-
larities between the physiological field and the quality of
© 2019 Nordic College of Caring Science
 Education and telephone follow-up intervention 7

Table 1 Characteristics of participants

Intervention Control
group group Total
(N = 31) (N = 31) (N = 62)

Characteristics of participants n % n % n % v2 P value

Gender Female 5 16.13 6 19.35 11 17.74 0.111 0.740*

Male 26 83.87 25 80.65 51 82.26
Age (years) Mean x  SS 56.23  10.16
59.35  12.05 57.79  11.17
t = 1.105 0.273
Educational status Primary school 16 51.61 19 61.29 35 56.45 1.477 0.478
High school 6 19.35 7 22.58 13 20.97
College/university 9 29.03 5 16.13 14 22.58
Marital status Single 6 19.35 6 19.35 12 19.35 0.000 1.000*
Married 25 80.65 25 80.65 50 80.65
Working status Working 16 51.61 13 41.94 29 46.77 0.583 0.445*
Not working 15 48.39 18 58.06 33 53.23
Living situation Alone 1 3.23 2 6.45 3 4.84 0.350 0.554*
With family 30 96.77 29 93.55 59 95.16
Income and expenditure situation Income less than Expenditure 4 12.90 11 35.48 15 24.19 4.543 0.103*
Income and Expenditure Balanced 23 74.19 18 58.06 41 66.13
Income more than Expenditure 4 12.90 2 6.45 6 9.68
Occupation Worker 11 35.48 7 22.58 18 29.03 2.346 0.504*
Office worker 3 9.68 2 6.45 5 8.06
Homemaker 1 3.23 3 9.68 4 6.45
Retired 16 51.61 19 61.29 35 56.45
Family history of heart disease Yes 22 70.97 19 61.29 41 66.13
No 9 29.03 12 38.71 21 33.87
Additional disease Yes 15 48.39 19 61.29 34 54.84 7.143 0.129*
Hypertension 3 9.68 11 35.48 14 22.58
Diabetes 1 3.23 2 6.45 3 4.84
Hypertension and diabetes 10 32.26 5 16.13 15 24.19
Other* 1 3.23 1 3.23 2 3.23
Explanation of cause of disease Smoking 6 19.35 6 19.35 12 19.35 2.730 0.742*
Nutrition 5 16.13 2 6.45 7 11.29
Obesity 1 3.23 0 0 1 1.61
Stress 16 51.61 20 64.52 36 58.06
Genetic 2 6.45 2 6.45 4 6.45
Destiny 1 3.23 1 3.23 2 3.23
Plan to change disease process Nothing to do 3 9.68 3 9.68 6 9.68 3.667 0.722*
Active life 1 3.23 2 6.45 3 4.84
Smoking cessation-reduction 7 22.58 8 25.81 15 24.19
Nutrition regulation 8 25.81 7 22.58 15 24.19
Obesity reduction 1 3.23 0 0 1 1.61
Stress reduction-coping 11 35.48 9 29.03 20 32.26
Praying 0 0 2 6.45 2 3.23
Sharing the disease process Yes 28 90.32 29 93.55 57 91.94 0.218 0.641*
No 3 9.68 2 6.45 5 8.06
Social support perception Yes 22 70.97 22 70.97 44 70.97 1.000 0.607*
Partly 7 22.58 5 16.13 12 19.35
No 2 6.45 4 12.90 6 9.68
Going to health control When ill 6 19.35 9 29.03 15 24.19 2.325 0.508*
Every few months 6 19.35 8 25.81 14 22.58
Once a year 5 16.13 2 6.45 7 11.29
I never went 14 45.16 12 38.71 26 41.94

*p> 0.05

© 2019 Nordic College of Caring Science

8 €
S. Turan Kavradim, Z. Canli Ozer

Control Intervention

Control Intervention

Baseline 12th week

b. Change in the mean of the patients' self-efficacy scale scores over time

Control Intervention

Baseline 12th week Baseline 12th week

Physical activity Insecurity Emotional reaction Dependency

Diet Medication Side effects

a. Change in the mean of the patients' quality of life subscale scores

over time Baseline 12th week Baseline 12th week

c. Change in the mean of the patients' coping and adaptation process scale scores over time

Figure 3 (a) Change in the mean of the patients’ subscale scores over time. (b) Change in the patients’ self-efficacy scores over time. (c) Change
of mean score of patients’ coping and adjustment process scale over time

life subscale in the model. In addition to this, it is improved the quality of life in cardiovascular disease
thought that the detection of change in compliance areas, patients (33,34).
stimuli and coping mechanisms of data collection form The self-efficacy of patients in the intervention group
based on the RAM and use of model-based intervention was found to be significantly increased (Fig. 3). In this
is effective in increasing the quality of life. In the litera- regard, it is seen that the research hypothesis is con-
ture, there was no study evaluating the efficacy of educa- firmed. Among the reasons for the effectiveness of the
tion or telephone follow-up on quality of life in coronary intervention are thought to be face-to-face predischarge
diseases based on the RAM. However, studies in different education and implementation of strengthening-encour-
patient populations based on the RAM seem to show an agement strategies with structured telephone follow-up
increase in the quality of life of patients (31,32). In addi- interventions based on the RAM. Self-efficacy includes
tion, the results of our study show similar results to other four basic processes: cognitive, motivational, emotional
studies using education and telephone follow-up inter- and selection (35). The cognitive and selection processes
vention (33,34). When different studies of telephone fol- of the patients were supported in this study by the edu-
low-up interventions were examined in patients with cation, and motivational and emotional processes were
cardiovascular disease, it was found that these interven- supported by telephone follow-up intervention. Further-
tions had positive effects on patient satisfaction and par- more, an aim of the study was to strengthen the coping
ticipation in cardiac rehabilitation, decreased stress and mechanisms of patients in order to establish effective
hospital admissions (7,10,11). Also, training and tele- adaptation behaviours according to the RAM. There are
phone follow-up interventions have significantly similarities between the coping mechanisms in the model

© 2019 Nordic College of Caring Science

 Table 2 Treatment effects from baseline to 12th week for quality of life, self-efficacy and coping and adaptation of the intervention and control group

© 2019 Nordic College of Caring Science

Intervention group Control group

Baseline After 12 weeks Baseline After 12 weeks

Variables Effect size
MIDAS domains n Mean  SD n Mean  SD t* P value n Mean  SD n Mean  SD t* p F** p value (cohen-d)***

Physical activity 33 43.55  21.83 31 16.33  16.34 7.02 0.0001 33 42.81  19.30 31 40.12  23.22 0.66 0.5163 2.86 0.0049* 1.18
Insecurity 33 30.73  20.49 31 14.61  17.57 6.35 0.0001 33 27.33  19.46 31 38.08  19.93 2.90 0.0070 2.73 0.0072* 1.25
Emotional reaction 33 42.14  25.10 31 16.94  18.55 6.44 0.0001 33 35.08  20.83 31 47.78  24.18 3.82 0.0006 2.72 0.0074* 1.43
Dependency 33 55.11  23.24 31 27.96  17.29 5.47 0.0001 33 41.40  17.81 31 45.43  24.99 1.09 0.2850 0.45 0.6509 0.81
Diet concerns 33 47.58  30.67 31 12.10  15.04 6.90 0.0001 33 31.45  23.15 31 31.18  23.86 0.05 0.9566 0.31 0.7593 0.95
Medication 33 63.31  32.59 31 22.18  22.53 5.81 0.0001 33 42.34  33.18 31 47.98  32.61 0.92 0.3645 0.40 0.6902 0.92
Side effects 33 33.87  34.79 31 12.90  17.52 3.12 0.0040 33 44.76  32.08 31 42.34  37.46 0.92 0.3645 3.50 0.0006* 1.00
General self-efficacy scale 33 27.71  5.40 31 34.45  3.70 6.21 0.0001 33 27.87  4.98 31 25.52  6.47 2.88 0.0072 4.22 0.0001* 1.69
Coping and Adaptation Scale 33 116.10  15.25 31 148.90  13.87 8.98 0.0001 33 121.71  13.33 31 111.58  18.03 0.37 0.7142 4.54 0.0001* 2.32

MIDAS: Myocardial Infarction Dimensional Assessment Scale.

*Differences between baseline and after 12 week in each group.
**Differences between experimental and control group (p < 0.05).
***Effect size was evaluated by calculator for Student’s t-test. (https://www.danielsoper.com/statcalc/calculator.aspx?xml:id=48).
Education and telephone follow-up intervention
9
10 €
S. Turan Kavradim, Z. Canli Ozer

Table 3 Treatment effects from baseline to 12th week for lifestyle habits

Baseline 12 weeks after discharge

Intervention Control Intervention Control

group group group group

Variables n % n % n % n % v2 P value

Symptoms experienced None 13 41.94 15 48.39 22 70.97 14 45.16 4.71 0.194

Fatigue and weakness 8 25.81 10 32.26 2 6.45 6 19.35
Shortness of breath 1 3.23 3 9.68 0 0 0 0
Chest pain 8 25.81 3 9.68 6 19.35 9 29.03
Other 1 3.23 0 0 1 3.23 2 6.45
Health status perception Good 16 51.61 11 35.48 23 74.19 10 32.26 11.08 0.004
Middle 13 41.94 18 58.06 7 22.58 17 54.84
Bad 2 6.45 2 6.45 1 3.23 4 12.90
Smoking habits Yes 16 51.61 14 45.16 9 29.03 10 32.26 0.99 0.608
Not smoking 7 22.58 11 35.48 15 48.39 17 54.84
Stopped smoking 8 25.81 6 19.35 7 22.58 4 12.90
Alcohol habits Yes 3 9.68 1 3.23 0 0 0 0
No 25 80.65 28 90.32 31 100 31 100 - -
Quit 3 9.68 2 6.45 0 0 0 0
Physical activity Yes 4 12.90 4 12.90 27 87.10 8 25.81 23.68 0.000
No 27 87.10 27 87.10 4 12.90 23 74.19
Active lifestyle Yes 16 51.61 12 38.71 20 64.52 10 32.26 23.60 0.000
Partly 7 22.58 9 29.03 11 35.48 4 12.90
No 8 25.81 10 32.26 0 0 17 54.84
Rest during the day Yes 18 58.06 22 70.97 28 90.32 23 74.19 3.49 0.175
Partly 9 29.03 5 16.13 3 9.68 6 19.35
No 4 12.90 4 12.90 0 0 2 6.45
Dietary behaviour I know what I need to eat 11 35.48 7 22.58 31 100 14 45.16 23.42 0.000
I do not know what to eat 20 64.52 24 77.42 0 0 17 54.84
I pay attention 10 32.26 11 35.48 29 93.55 19 61.29 9.53 0.023
I do not pay attention 2 6.45 1 3.23 0 0 2 6.45
I do not pay much attention 11 35.48 12 38.71 2 6.45 9 29.03
I never pay attention 8 25.81 7 22.58 0 0 1 3.23

and the concept of self-efficacy. To our knowledge, there

is no study evaluating the efficiency of the RAM on self-
efficacy in coronary diseases, but it has been shown that
the application of this model with a care plan in elderly
individuals had positive effects on improving self-efficacy
(36). It is known that increasing self-efficacy in disease
management influences behavioural choices and has pos-
itive effects on lifestyle change (5,37,38).
In the present study, the coping and adaptation process
score increased in the intervention group of the study,
whereas it decreased significantly in the control group
(Fig. 3). It is thought that the telephone follow-up was
an important intervention that contributed to the coping
and adaptation processes in terms of early detection and
control of symptoms, the provision of fast, useful and
effective solutions, information exchange and improve-
ment in the quality of the health education of the
patients. It has been observed in studies that RAM con-
tributed to the coping and adaptation process of patients
(39,40).
Changes in lifestyle habits during the study period
In Turkey generally, there is no systematic cardiac reha-
bilitation programme at most centres after MI, and thus,
no routine monitoring system is applied to follow-up
changes in the lifestyle of patients. It is stated that the
period in which patients with cardiovascular disease are
most likely to discontinue their medication is one to
three months after discharge (41,42). In this study, medi-
cation adherence was high in both groups and there was
no statistically significant difference in drug adherence in
the groups. Although some studies were conducted by
telephone follow-up intervention, medication adherence
was significantly increased compared with the control
group (43,44). In contrast to these studies, other studies
determined that education and counselling interventions
were not effective (45,46). And also when studies of
RCTs were examined, it was shown that education and
telephone follow-up interventions had positive effects on
nutrition and physical activity (46–49).

© 2019 Nordic College of Caring Science

 Education and telephone follow-up intervention 11

0.0458*

0.0114*

BMI: body mass index (kg/m2); HbA1C, haemoglobin A1C (mmol/L)); HDL, high-density lipoprotein (mg/dL); LDL, low-density lipoprotein (mg/dL); Trig, triglycerides (mg/dL); glucose, mg/dL; WC, waist
P value

0.4083
0.5127
0.2082
0.5076

0.1312
Psychosocial adaptation fields
MI makes adaptation difficult by affecting an individual’s
physiological, self-concept, role function and interdepen-

2.02
0.83
dence fields. The aims of a nurse in this process were to

0.66
1.27
0.67
2.57
1.52
F**
change ineffective adaptation behaviours into effective
P value ones and to maintain or develop existing effective adap-

0.0341
0.0003
0.2474
0.2979
0.4226
0.6499
0.3389
tation behaviours. In research in the physiological field
relating to the fields of psychosocial adaptation, signifi-
cant results have been obtained on the topic of nutrition,
exercise and an active life. Examination of randomised
2.30
4.57
1.20
1.07
0.83
0.46
0.97
controlled studies in the literature in which education
t*

and monitoring by telephone were used has shown that

they have beneficial effects on nutrition and physical
26.38
67.36
49.67

12.53
5.74

1.46

3.86
activity (46–49). Psychosocial problems such as feeling
Mean  SD

bad about oneself, uncertainty about the future, hope-








After 12 weeks

6.79
36.00
82.50

28.42
172.53
121.11

106.68

lessness and feelings of guilt are related to the field of

concept of self. When the state of perception of health
was considered in the study, it was seen that the state of
feeling good was better in the intervention group than in
18
18
17
18
13
31
31
n

the control group.

No randomised controlled studies with cardiovascular
193.47
35.29

57.23

11.55
Table 4 Changes in physical parameters related to lifestyle between the intervention and control group during follow-up

8.77

1.54

3.87

diseases were found in the literature based on the Roy

Mean  SD

Adaptation Model. In studies with other patient popula-









tions using the RAM, the levels of effect of education on

6.46
33.26
112.19

28.54
230.39
138.06

107.03
Control group

adaptation fields were investigated. In two studies inves-

Baseline

tigating the effectiveness on psychosocial adaptation

fields of theory-based patient education based on the
31
31
31
31
31
31
31
n

RAM in increasing adaptation in haemodialysis patients,

it was shown that patients’ adaptation in the physiologi-
P value

0.3765
0.0001
0.7495
0.0899
0.3643
0.0017
0.0067

cal and self fields increased in the intervention group

compared with the control group, providing physical,
psychological and social adaptation (4,50). In a ran-
0.90
5.36
0.32
1.78
0.93
3.46
2.91

domised controlled study examining the effects on physi-

t*

cal and psychosocial adaptation of patient education

given based on the RAM to patients with chronic
119.31
11.22
47.04

39.68

11.50

obstructive pulmonary disease, it was found that the edu-

0.93

4.26

*Differences between baseline and after 12 weeks in each group.

cation given to the intervention group increased adapta-

Mean  SD









tion to the illness in three modes – psychological, self-

After 12 weeks

40.92
87.19

27.15
179.74
102.76

100.10
6.24

concept and role function modes. In addition to this, no

**Differences between experimental and control group.

significant increase was observed in the interdependence

mode of the RAM (51). In another randomised controlled
26
26
23
21
20
31
31

study examining adaptation in individuals with heart fail-

n

ure to education based on the RAM, increases in

129.95

patients’ quality of life, functional capacities and receipt

46.41
38.30

62.10

12.85
1.39

4.45

of social support were seen compared with the control

Mean  SD
Intervention group









group (31).
6.46
47.65
125.45

27.57
199.71
128.29

102.48

Limitations
Baseline

circumference (cm).

While the study did have some strengths (single-blind,

31
31
31
31
31
31
31
n

concealed random assignment, clear inclusion/exclusion

criteria, the use of reliable and valid outcome measures,
Variables

Glucose
HbA1C

obtaining some preliminary feedback on the intervention

HDL

BMI
WC
Trig
LDL

and the assessment of range of potentially relevant

© 2019 Nordic College of Caring Science

12 €
S. Turan Kavradim, Z. Canli Ozer

outcome measures), the study did have some limitations.
The limitations of this trial were 1) the self-reported mea-
sure of physical activity and nutrition behaviour, 2) due
to the nature of the intervention it was impossible to
blind the researcher so patients provided data to a single
interventionist, 3) the study is limited to the patients
who had MI in University Hospital Cardiology Clinic
between April 2016 and August 2017, 4) the study had a
small sample and was performed at a single centre and 5)
the population was limited about primarily male, pre-
sumably of Turkish descent and related to only including
those patients with sufficient reading and writing skills,
as well as mobility and transportation access. Thus, the
results cannot be generalised to all patients.
RAM and telephone follow-up studies should be carried
out in which the follow-up period is longer to obtain sig-
nificant positive results on smoking habits, physical
parameters and managing symptoms.
Acknowledgements
The authors want to thank the cardiology clinic team at
University Hospital for their support and advice and MI
patients for participating.
Conflict of interest
No conflict of interest has been declared by the authors.

Conclusion
In conclusion, it has been established that nursing care
given based on education based on the RAM and tele-
phone follow-up can be applied to individuals who have
undergone MI. The results from this study indicate that
education and telephone follow-up intervention based on
the RAM had positive and significant results after
12 weeks on quality of life, self-efficacy and coping and
adaptation process, and on enhancing exercise and diet
adherence compared to the control group. The findings
of this study are important for health professionals who
care for individuals with MI to develop nursing care.
Based on the research process and the results obtained, it
is recommended that education based on the RAM and
telephone follow-up should be performed, that an educa-
tion booklet should be used in education in the clinic
before the patient is discharged and that the education
booklet should be given to the patient, and that a post-
discharge tele-monitoring system should be formed for
management of the postillness process. Due to the small
number of participants in the study, further research is
recommended to conduct with larger sample. It is also
recommended that studies of education based on the
Funding
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-
profit sectors.
Ethical approval
Before starting the research, permission was obtained from
University Hospital. In addition, ethics committee approval
(Approval No: 2012-KAEK-20) was obtained from the
Ethics Committee for Clinical Investigations of University.
This study was conducted in accordance with the princi-
ples of the Helsinki Declaration. Written informed consent
also was obtained from each participant.
Author contribution
Selma Turan Kavradım and Zeynep Ozer € made substan-
tial contributions to conception and design. Selma Turan
Kavradım collected the data and a statistic expert anal-
ysed the data. Each author is responsible for the theoreti-
€
cal approaches. Zeynep OZER supervised and reviewed
the drafting of the manuscript.

References myocardial infarction in patients European Journal of Medicine. 2013; 8:

1 Ibanez B, James S, Agewall S,
Antunes MJ, Bucciarelli-Ducci C,
Bueno H, Caforio ALP, Crea F,
Goudevenos JA, Halvorsen S, Hin-
dricks G, Kastrati A, Lenzen MJ,
Prescott E, Roffi M, Valgimigli M,
Varenhorst C, Vranckx P, Widimsk y
P. 2017 ESC Guidelines for the man-
agement of acute myocardial infarc-
tion in patients presenting with ST-
segment elevationThe Task Force for
the management of acute
presenting with ST-segment eleva-
tion of the European Society of Car-
diology (ESC). Eur Heart J 2018; 39:
119–77.
2 Cepeda-Valery B, Cheong AP, Lee A,
Yan BP. Measuring health related
quality of life in coronary heart dis-
ease: The importance of feeling well.
Int J Cardiol 2011; 149: 4–9.
3 Rancic NK, Petrovic BD, Apostolovic
SR, Kocic BN, Ilic MV. Health-related
quality of life in patients after the
acute myocardial infarction. Central
266–72.
4 Afrasiabifar A, Karimi Z, Hassani P.
Roy’s adaptation model-based patient
education for promoting the adapta-
tion of hemodialysis patients. Iran
Red Crescent Med J 2013; 15: 566–72.
5 Hannah K, Holly M. The role of self-ef-
ficacy in cardiovascular disease self-man-
agement: A review of effective programs.
2010.
6 Amsterdam EA, Wenger NK, Brindis
RG, Casey DE, Ganiats TG, Holmes
DR, Jaffe AS, Jneid H, Kelly RF,

© 2019 Nordic College of Caring Science


Kontos MC, Levine GN, Liebson PR,
Mukherjee D, Peterson ED, Sabatine
MS, Smalling RW, Zieman SJ. AHA/
ACC Guideline for the Management
of Patients With Non–ST-Elevation
Acute Coronary Syndromes: A
Report of the American College of
Cardiology/American Heart Associa-
tion Task Force on Practice Guideli-
nes. J Am Coll Cardiol 2014; 64:
e139–e228.
7 Eshah NF, Bond AE. Cardiac rehabil-
itation programme for coronary heart
disease patients: an integrative litera-
ture review. Int J Nurs Pract 2009;
15: 131–9.
8 Beswick AD, Rees K, West RR, Tay-
lor FC, Burke M, Griebsch I, Taylor
RS, Victory J, Brown J, Ebrahim S.
Improving uptake and adherence in
cardiac rehabilitation: literature
review. J Adv Nurs 2005; 49: 538–55.
9 Karmali KN, Davies P, Taylor F, Bes-
wick A, Martin N, Ebrahim S. Pro-
moting patient uptake and adherence
in cardiac rehabilitation. Cochrane
Database Syst Rev 2014; 25:
Cd007131.
10 Harkness K, Smith KM, Taraba L,
Mackenzie CL, Gunn E, Arthur HM.
Effect of a postoperative telephone
intervention on attendance at intake
for cardiac rehabilitation after coro-
nary artery bypass graft surgery.
Heart Lung 2005; 34: 179–86.
11 Hawkes AL, Patrao TA, Atherton J,
Ware RS, Taylor CB, O’Neil A, Fore-
man R, Oldenburg BF. Effect of a tele-
phone-delivered coronary heart
disease secondary prevention program
(proactive heart) on quality of life and
health behaviours: primary outcomes
of a randomised controlled trial. Int J
Behav Med 2013; 20: 413–24.
12 Coorey GM, Neubeck L, Mulley J,
Redfern J. Effectiveness, acceptability
and usefulness of mobile applications
for cardiovascular disease self-man-
agement: Systematic review with
meta-synthesis of quantitative and
qualitative data. Eur J Prev Cardiol
2018; 25: 505–21.
13 Gandhi S, Chen S, Hong L, Sun K,
Gong E, Li C, Yan LL, Schwalm JD.
Effect of mobile health interventions
on the secondary prevention of car-
diovascular disease: systematic
review and meta-analysis. Can J Car-
diol 2017; 33: 219–31.
© 2019 Nordic College of Caring Science
Education and telephone follow-up intervention
14 Pfaeffli Dale L, Dobson R, Whittaker
R, Maddison R. The effectiveness of
mobile-health behaviour change
interventions for cardiovascular dis-
ease self-management: A systematic
review. Eur J Prev Cardiol 2016; 23:
801–17.
15 Fawcett J. Using the Roy adaptation
model to guide research and/or
practice: construction of conceptual-
theoretical-empirical systems of
knowledge. Aquichan 2009; 9: 297–
306.
16 Whittemore R, Sister Callista R.
Adapting to diabetes mellitus: a the-
ory synthesis. Nursing Sci Q 2002; 15:
311–7.
17 J. Fawcett SD-M. Contemporary
Nursing Knowledge: Analysis and
Evaluation of Nursing Models and
Theories. 2013.
18 Roy SC. The Roy adaptation model,
3rd. edn. 2008, Pearson Education,
1–576.
19 Salminen-Tuomaala M, Astedt-Kurki
P, Rekiaro M, Paavilainen E. Coping
experiences: a pathway towards dif-
ferent coping orientations four and
twelve months after myocardial
infarction-a grounded theory appro-
ach. Nurs Res Pract 2012; 2012:
674783.
20 Ahyana S, Kritpracha C, Thaniwat-
tananon P. Cardiac Rehabilitation
Enhancing Programs in Patients with
Myocardial Infarction: A literature
Review. 2013.
21 Boutron I, Altman DG, Moher D,
Schulz KF, Ravaud P. CONSORT
Statement for Randomized Trials of
Nonpharmacologic Treatments: A
2017 Update and a CONSORT Exten-
sion for Nonpharmacologic Trial
Abstracts. Ann Intern Med 2017; 4:
40–47.
22 Roy SC. Research based on the Roy
adaptation model: last 25 years.
Nursing Sci Q 2011; 24: 312–20.
23 Charnock D. DDISCERN Handbook
Quality Criteria for Consumer Health
Information on Treatment Choices,
1998, Radcliffe Medical Press, Oxon.
24 Schwarzer R, Jerusalem M. Gener-
alized self-efficacy scale. In Measures
in Health Psychology: A User’s Portfo-
lio. Causal and Control Beliefs, (Wein-
man J, Wright S, Johnston M eds),
1995, NFER-NELSON, Windsor, UK,
35–37.
13
25 Aypay A. The Adaptation Study of
General Self-Efficacy (GSE) Scale to
Turkish. Inonu University Journal of
the Faculty of Education 2010; 11:
113–31.
ß atal E, AD. A validity and reliability
26 C
study of the coping and adaptation
processing scale in Turkey. Euro
Heart J Acute Cardiovas Care Abst Suppl
2015; 1: 44.
27 Thompson DR, Jenkinson C, Roe-
buck A, Lewin RJ, Boyle RM, Chan-
dola T. Development and validation
of a short measure of health status
for individuals with acute myocardial
infarction: the myocardial infarction
dimensional assessment scale
(MIDAS). Qual Life Res 2002; 11:
535–43.
28 Yilmaz E, Eser E, Sekuri C, Kultursay
H. The psychometric properties of
the Turkish version of Myocardial
Infarction Dimensional Assessment
Scale (MIDAS). Anatol J Cardiol
2011; 11: 386–401.
29 Morisky DE, Green LW, Levine DM.
Concurrent and predictive validity of
a self-reported measure of medica-
tion adherence. Med Care 1986; 24:
67–74.
30 Bahar G, Savasß HA, Unal € A, Savasß E,
Kaya H, Morisky Bahar A. Tedavi
Uyum Olc € ßeginin iki ucßlu duygudu-
rum bozuklugu icßin gecßerlilik ve
g€uvenilirlik ßcalısßması. Anatol J Psy-
chiat 2014; 15: 141–9.
31 Bakan G, Akyol AD. Theory-guided
interventions for adaptation to heart
failure. J Adv Nurs 2008; 61: 596–
608.
32 Lefaiver CA, Keough V, Letizia M,
Lanuza DM. Using the Roy Adapta-
tion Model to explore the dynamics
of quality of life and the relationship
between lung transplant candidates
and their caregivers. ANS Adv Nurs
Sci 2007; 30: 266–74.
33 Chan DS, Chau JP, Chang AM. Acute
coronary syndromes: cardiac rehabili-
tation programmes and quality of life.
J Adv Nurs 2005; 49: 591–9.
€
34 Kurcßer MA, Ozbay A. Koroner arter
hastalarında uygulanan yasßam tarzı
egitim ve danısßmanlıgının yasßam
kalitesine etkisi. Anatol J Cardiol
2011; 11: 107–14.
35 Bandura A. Self-efficacy. Encyclopedia
of human Behavior. New York, Aca-
demic Press, 1994.
14 €
S. Turan Kavradim, Z. Canli Ozer
36 Maghsoudi E, Maslak M, Zareie F,
Pour Rashid S, Sofiyani A.The Effect
of Care Plan Application Based On Roy
Adaptation Model on the Self-Efficacy in
Elderly People in Urmia Nursing Homes.
2015.
37 Marks R, Allegrante JP, Lorig K. A
review and synthesis of research evi-
dence for self-efficacy-enhancing
interventions for reducing chronic
disability: implications for health
education practice (part I). Health
Promot Pract 2005; 6: 37–43.
38 Sarkar U, Ali S, Whooley MA. Self-
efficacy and health status in patients
with coronary heart disease: findings
from the heart and soul study. Psy-
chosom Med 2007; 69: 306–12.
39 Fl
orez-Torres IE, Herrera-Alarc on E,
Carpio-Jim enez E, Veccino-Amador
MA, Zambrano-Barrios D, Reyes-
Narv aez Y, Torres-Contreras S.
Afrontamiento y adaptaci on en
pacientes egresados de unidades de
cuidado intensivo. Aquichan 2011;
11: 23–39.
40 Kroemeke A. Changes in well-being
after myocardial infarction: Does
coping matter? Qual Life Res 2016; 1:
2593–601.
41 Ho PM, Spertus JA, Masoudi FA, Reid
KJ, Peterson ED, Magid DJ, Krumholz
HM, Rumsfeld JS. Impact of medica-
tion therapy discontinuation on mor-
tality after myocardial infarction. Arch
Intern Med 2006; 25: 1842–7.
42 Lee HY, Cooke CE, Robertson TA.
Use of secondary prevention drug
therapy in patients with acute coro-
nary syndrome after hospital dis-
charge. J Manag Care Pharm 2008;
14: 271–80.
43 Al-Ganmi AH, Perry L, Gholizadeh
L, Alotaibi AM. Cardiovascular medi-
cation adherence among patients
with cardiac disease: a systematic
review. J Adv Nurs 2016; 72: 3001–
14.
44 Rinfret S, Rodes-Cabau J, Bagur R,
Dery JP, Dorais M, Larose E, Bar-
beau G, Gleeton O, Nguyen CM,
Noel B, Proulx G, Roy L, Taillon I,
Larochelliere R, Bertrand OF. Tele-
phone contact to improve adherence
to dual antiplatelet therapy after
drug-eluting stent implantation.
Heart2013; 99: 562–9.
45 Amado Guirado E. Pujol Ribera E,
Pacheco Huergo V, Borras JM.
Knowledge and adherence to antihy-
pertensive therapy in primary care:
results of a randomized trial. Gac
Sanit 2011; 25: 62–67.
46 Jiang X, Sit JW, Wong TK. A nurse-
led cardiac rehabilitation programme
improves health behaviours and car-
diac physiological risk parameters:
evidence from Chengdu, China. J
Clin Nurs 2007; 16: 1886–97.
47 Craigie AM, Barton KL, Macleod M,
Williams B, van Teijlingen E, Belch JJ,
Anderson AS. A feasibility study of a
personalised lifestyle programme
(HealthForce) for individuals who
have participated in cardiovascular risk
screening. Prev Med 2011; 52: 387–9.
48 Maddison R, Pfaeffli L, Whittaker R,
Stewart R, Kerr A, Jiang Y, Kira G,
Leung W, Dalleck L, Carter K, Raw-
storn J. A mobile phone intervention
increases physical activity in people
with cardiovascular disease: Results
from the HEART randomized con-
trolled trial. Eur J Prev Cardiol 2015;
22: 701–9.
49 Mok VK, Sit JW, Tsang AS, Chair
SY, Cheng TL, Chiang CS. A con-
trolled trial of a nurse follow-up
dietary intervention on maintaining
a heart-healthy dietary pattern
among patients after myocardial
infarction. The. J Cardiovasc Nurs
2013; 28: 256–66.
50 Kacaroglu Vicdan A, Gulseven
Karabacak B. Effect of treatment
education based on the Roy Adapta-
tion Model on adjustment of
hemodialysis patients. Clin Nurse Spec
2016; 30: 1–13.
51 Akyil RC, Erguney S. Roy’s adapta-
tion model-guided education for
adaptation to chronic obstructive
pulmonary disease. J Adv Nurs 2013;
69: 1063–75.
Supporting Information
Additional Supporting Information
may be found in the online version
of this article:
Appendix S1. 2017 CONSORT
checklist of information to include
when reporting a randomized trial
assessing nonpharmacologic treat-
ments (NPTs).
© 2019 Nordic College of Caring Science